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What is PCOS: Everything You Need to Know

What is PCOS? PCOS stands for Polycystic Ovarian Syndrome – which describes the condition of having multiple small cysts on the ovaries. Up to 15 percent of women in the states suffer from PCOS. It is the leading cause of infertility in the Western world.

What is PCOS: The Diagnosis

In order to be diagnosed with PCOS, women need to have at least two of the three following characteristics:

1) Irregular or absent menstrual cycles

2) Elevated testosterone or other male sex hormone levels

3) Poly cystic ovaries (diagnosed via ultrasound)

What is PCOS: Signs and symptoms

PCOS is a disorder of the endocrine system.Testosterone is the primary hormone to be concerned about for most women, though a hormone produced by the adrenal glands called DHEA-S is also a major concern.

Sometimes female sex hormone levels are low, but that’s not always the case. The two hormones to be on the look out for here are estrogen and progesterone. They need to be in proper balance with testosterone in order for the menstrual cycle to function normally.

When the menstrual cycles stops functioning normally, here are any of the symptoms you may experience. Most women with PCOS suffer from some, but not all, of the symptoms:

-Unpredictable ovulation

-Irregular or absent menstruation


-Acne, which typically appears around the mouth, chin, and jawline

-Male pattern hair growth (hirsutism)

-Male pattern hair loss (alopecia)

-Weight gain and increased difficulty in losing weight

-Low libido

-Difficulty sleeping

-Mood swings or disruptions in regular mood

What is PCOS: What Happens to the Menstrual Cycle

In order to understand how menstrual dysfunction occurs, it is important first to review normal menstruation:

The first day of a menstrual cycle is the first day of bleeding. During this period, the lining of the uterus is shed. This bleeding constitutes the first 3-8 days of the first half of the menstrual cycle, which lasts about two weeks and is called the follicular phase. Throughout the follicular phase, levels of estrogen rise and make the lining of the uterus grow and thicken.

During this phase pituitary gland produces follicle-stimulating hormone (FSH). FSH stimulates the growth of 3 to 30 follicles. Each follicle contains an egg. With time, the levels of FSH decrease, so only one of the follicles continues to grow. It produces estrogen, and other stimulated follicles break down.

Detecting this shift, the pituitary then releases luteinizing hormone (LH). This makes the follicle bulge and rupture, releasing its egg. This is ovulation. During ovulation testosterone surges, and estrogen drops.

After ovulation comes the luteal phase. Here the ruptured follicle closes and forms the corpus luteum.  This makes the endometrium thicken, which produces progesterone. Estrogen rises again too. But if the egg has not been fertilized during ovulation or in the days immediately following ovulation, progesterone levels fall. This triggers shedding and bleeding. Here the cycle begins again. Cycles are generally “known” to be 28 days long, but the length of a regular, healthy cycle can vary from ~20 to ~35 days.


We remain a bit uncertain precisely where the problem enters into the picture with PCOS, but something we know for sure it that it varies between women. Some possibilities are that:

-Low levels of the hormone sex-hormone binding globulin, a “result” of PCOS, decreases the rate of conversion from testosterone to estrogen. This might make estrogen too low to send the proper signals to the pituitary.

-High androgen levels coming right from the ovary or from the adrenal glands can block estrogen and progesterone activity.

-Insufficient pituitary signaling with LH or FSH could be the primary problem. In PCOS, the ratio of LH to FSH is typically around 2:1, instead of the more normal 1:2.

-Failure to signal progesterone elevation and decline. The one hormone that is absolutely crucial for menstruation is progesterone. Without progesterone, the corpus luteum never “knows” when to shed.

The question of what precisely is going on in each woman’s body is a complicated one. Therefore, it’s important to test testosterone, DHEA-S, estrogen, progesterone, LH and FSH at the very least when trying to figure out precisely what’s going on with your PCOS. A liver panel, fasting glucose levels, thyroid tests, micronutrient levels, and adrenal hormone such as cortisol are all important for background endocrine understanding, too.

What is PCOS: What now?

Do you suffer from acne? From facial hair growth? From trouble with weight gain? It is possible that you have PCOS.

The first and most important thing to do when you have PCOS is get educated! PCOS on the surface is very complicated – many different factors can play a role, and it is different for every woman. Fortunately I’ve figured a great deal of it out and have blogged about it extensively. Through the posts on this blog and in working with my manual, you can figure out what’s causing your PCOS, and how to overcome it.

You can learn more about what PCOS is in my posts “What Causes PCOS?” and “PCOS Treatment Options” – as well as in my comprehensive program for overcoming PCOS: PCOS Unlocked: The Manual.


What is PCOS? You tell me! What has PCOS been to you? What is your experience?





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Managing director of Paleo for Women and author of Sexy by Nature.


  1. I am so excited for this site! I’m currently struggling to lose a lot of weight and get a natural cycle back with PCOS, but it seems paleo is putting weight on me?! 🙁

    • Hi Michelle,
      That depends on what foods you’re eating, and how, on your paleo diet. Hopefully my other posts will help you a bit with that– otherwise, fill me in a bit more here and I’ll see what I can do to help.

  2. Thank you, Pepper 🙂 I’m 5’5”, 204lbs (the Paleo cycle I’m about to describe got me from 187 to 204!). So this is what happens: I go strict paleo (lots of greens, coconut oil, butter, organic meats, poultry, fish… and low carb) for about a week. I get extremely ‘down in the dumps’, which is very unlike me, and I my face starts gaining weight, and above my waist (back, arms, neck) starts gaining weight. So after a week of tolerating that I have a safe starch (or a non-safe starch) and I literally deflate! My stomach gets flatter and I get happier. After a few days of eating starches again my blood sugar swings come back and I start to gain weight again! I completely believe in the Paleo philosophy, but I can’t figure out what the h*** my body is up to. I’m starting metformin soon and am not on any other meds.I don’t overeat past full. I hate to say it, but it seems the more meat and fat I eat, the more weight I gain 🙁

    • When you began eating starches again, how much starch was it? I think there is a happy balance for everybody– it just takes some troubleshooting to figure it out. I’m sure you’ve thought of this, but I thought I’d run it past you again.
      I have some remaining questions. You can answer them or just think about them and try to tailor your diet appropriately.
      Have you been tested for insulin resistance? How much do you exercise?
      From my perspective, calories matter. I think we should always eat to satiation, but sometimes when our metabolism’s are dysregulated, satiation occurs after a point of weight maintenance. You don’t want to signal to your body that you are starving, but you do want to make sure you are hungry before you eat. Try alternating between average calorie days and lower calorie days, and see if that helps. I’d also recommend intermittent fasting– or at least trying it. For some people who are trying to lose weight, it really works wonders. If you find that it doesn’t work (say, just making sure you go 15 hours between dinner and breaking your fast), then go the alternate route and try to eat fewer, smaller meals. I find that smaller meals works better for me. I have always had a lot of stress circulating in my system, especially with regards to food and how much I am eating, so its important for me to eat regularly to convince my body I am not starving, and to convince it it doesn’t have to store every ounce of the food I eat.

      • Thank you! I was told I automatically have IR since I have PCOS (and I do get blood sugar swings)… but was never tested. I will try the frequent small meals. I find in paleo blogs and books it seems the guys lose all the weight and eat whatever they want. I was trying to do this but it wasn’t helping. I’ll keep what you said about calories in mind. Thanks!

    • I have another idea for you to consider. Dr Ron Rosedale, a low carbohydrate advocate, makes an important point that saturated fats are harder to burn than other fats. This is because they’re almost always larger. Mitochondria have a harder time burning the longer fats, and Rosedale asserts they can’t really burn anything (at least not without breaking them down first) longer than 12 carbon molecules. Most saturated fats are longer than that. Coconut oil is a unique saturated fat, and is mostly a medium chain fatty acid. This is partly why people such as Paul Jaminet recommend eating coconut oil for weight loss. So coconut oil is a good fat to focus on, as is all of the shorter chain fatty acids. Mono and poly- unsaturated fats such as olive oil and omega 3s in fish are helpful.
      So Rosedale advocates staying away from saturated fat for at least the first few weeks of low carb dieting, while the body takes time getting used to burning fat.

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  5. Hello,

    I’ve been tested for PCOS in the past – testosterone, estrogen, and an ultrasound, with negative results. However, I have multiple symptoms. Up until very recently I was of low normal weight, but had very irregular periods, hirsutism, and acne. This past year I have gained a lot of weight due to stress, overeating, and lack of exercise. I have slowly been adapting more and more Paleo into my life recently to overcome disordered eating patterns, and it has been very healing. I am wondering if Paleo can help treat my PCOS symptoms as well. The irregular periods and acne don’t bother me as much (I use topical medications for the acne.) However, the hirsutism is more uncomfortable. Do you have any dietary or supplement recommendations?

    I also switched from running to Crossfit which is where I started gaining weight. I stopped doing Crossfit after 3 months because I didn’t like the changes that were happening. I don’t know it was all mental, or if my body gained muscle more than others, or if maybe I just needed to gain. Regardless, I am wanting to incorporate more exercise into my life and don’t know where to start. There are so many mixed message about what is “best.” What do you suggest for stress regulation, physical fitness, and a Paleo lifestyle?

    Thank you,

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  7. Hello Stefani! I have a question…first I will explain my case. I’ve been having acne since 16 years old, now I’m 29. In 2012 I had diagnosis of PCOS, my period was 45 days, hair loss, oily and hair skin. I didn’t want to take birth control pills, so the doctor prescribed metformin + spironolactone. So I changed to Glucophage xr. After some months my skin was better. So I stoped to take them. The hair loss never stopped, the loww ferritins also helps. And now my acne came back worse, I have hair groth in my face. My TSH, the doctor said is higher to my age. And my thyroid is enlarged. So she prescribed Metformin xr 500mg and Levothyroxine 25mcg. This week I had blood test results, and my testosteron and the other hormons are ok. She said I have Hashimoto’s thiroiditis, and incresead the metformin to 1g, and levothyroxine to 50mcg on monday, wednesday and friday. What do you think about that ? I’m reading your book “Clearer skin in 7 days”. And you said acne is related to autoimmune condition, in my case Hashimoto. I read that Brazil nuts are good to thyroid health, because they have selene, antioxidants etc. Do you know if they have omega 6 oil which causes acne?

    • Brazil nuts do have omega 6 but if you only have one/day you should be okay. The selenium is important. If you do in fact have Hashimoto’s I think probably the best thing you can do for your health — both overall health and the health of your skin — is focus on gut healing. that means eliminating potentially problematic foods like grains and dairy and also focusing on gut healing foods like bone broth (or gelatin supplements – check out Vital Proteins! 🙂 ) and fermented foods 🙂

  8. Hey, Just want your initial opinion on what hormones I should get tested. I have a few symptons of pcos, but of course it could be from some other imbalance. Ok here are my symptoms: acne on back, shoulders, some on chest and some on face(this has been a constant since puberty). My periods are very regular but very painful the first day, faint worthy cramps and large clotting. Some months I do not think I ovulate.I have lots of chin hairs. My hair has gotten alot thinner. Chronic constipation. Low Energy. Depression. Inability to lose weight. Low libido.My Past: I have always struggled with maintaining a normal,healthy weight. This lead me to abusing laxatives(due to constipation) and diet pills when I was about 18. When I got to college I partied and ended up gaining about 30 lbs. I then got on adderall for about 6 months. This helped me lose around 40 lbs dropping me to my lowest weight of 138 (im 5’7″) I gradually gained weight back over the past 8 years and has been impossible to lose anything. I am pretty sure I have alot of inflammation in my body from abusing stimulants in my past. I now only have green tea. I have only recently quit coffee. I eat a paleo diet now (I was vegan for a couple years which only left me with an insatiable appetite) I workout regularly with weights, walking and some yoga. My current weight is 166 and I feel bloated and heavy all the time. I am currently taking:Iodine, iodine factors(for increased absorbtion) fish oil sport from Nordic naturals and intestinal movement formula from healthforce. I have been on this regiment about a week and I think it is helping but not sure. I have taken tons of probiotics and never found help from any.

    • I think you are probably on the right track – the thyroid could be an issue. Be sure to get some selenium too with the iodine however because the thyroid gland needs both to function. And inflammation – yes I think you are correct on this score.

      I would test testoterone, DHEA-S, LH, FSH, estrogen (all types), progesterone, vitamin D levels, and all of the thyroid hormones: T3, T4, TSH, and also TPO for hashimoto’s antibodies. 🙂

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